[Transcatheter valve-in-valve implantation in a patient with a degenerative sutureless aortic bioprosthesis: case report and literature review]. / Impianto transcatetere di valvola aortica in paziente con bioprotesi aortica sutureless degenerata: descrizione di un caso e revisione della letteratura.

Sutureless aortic bioprostheses (SAB) provide shorter aortic cross-clamp time and cardiopulmonary bypass duration compared to conventional aortic valve replacement. Similarly to other bioprostheses, reintervention may become necessary in some cases because of long-term structural degeneration of the valve. Valve-in-valve (ViV) transcatheter aortic valve replacement may represent an effective and safe alternative to aortic valve replacement in patients with degenerated bioprostheses who carry a high risk for reintervention. We report the case of a self-expandable transcatheter ViV procedure in a degenerated SAB.

Coronary flow velocity pattern assessed by transthoracic Doppler echocardiography predicts adverse clinical events and myocardial recovery after successful primary angioplasty.

BACKGROUND: Doppler guidewire studies demonstrated that specific velocity patterns in the left anterior descending coronary artery (LAD) after primary percutaneous coronary intervention (PCI) predict myocardial recovery and clinical outcome. The present study assessed whether similar results can be achieved by transthoracic Doppler echocardiography (TTDE). METHODS: Coronary flow velocities of LAD were evaluated by TTDE in 35 consecutive patients with anterior acute myocardial infarction who were treated with successful primary PCI plus stenting, performed within 6 h after the onset of symptoms or within 6-12 h if there was evidence of continuing ischaemia. Coronary-flow velocity of the LAD was achieved after 12 h and within 48 h after the PCI; TTDE standard examination was repeated after 2 months of follow-up. RESULTS: Three patterns were found: (i) 'pattern A' with good antegrade systolic flow and slow diastolic deceleration rate (63.7%); (ii) 'pattern B' with reduced or absent systolic flow and rapid diastolic deceleration rate (9.1%); and (iii) 'pattern C' with protosystolic retrograde flow and rapid diastolic deceleration rate (27.2%). The clinical characteristics and echocardiographic data were compared: wall-motion-score-index (WMSI), ejection fraction, end-diastolic volume (EDV) after PCI (T1) and after 2 months (T2). Patients with pattern A demonstrated recovery of contractile function (WMSI-T1 1.48 + or - 0.42/WMSI-T2 1.29 + or - 0.29, P < 0.05) and better clinical outcome; patients with patterns B and C ran into ventricular remodelling (EDV-T1 89 + or - 6.3 ml/EDV-T2 123 + or - 25 ml, P = 0.002) and more early and late complications. CONCLUSIONS: TTDE is a reliable method to achieve coronary flow velocities in LAD after an anterior acute myocardial infarction and it could be useful to evaluate no-reflow phenomenon at bedside and thus clinical outcome.